The VA’s Dirty Little Secret List

by Julianne Haydel on May 14, 2014

A couple of years ago, I was in a client’s agency when a woman came in to ask about her father’s home visit schedule. The case manager was confused because the gentleman had been sent to the VA hospital in Texas a few days prior and the agency had no idea he had returned home.

I pulled his chart while they were talking. The nursing notes described a stasis ulcer to the lower extremity with wound care for almost a year. The wound continued to deteriorate. The patient had a physician at the VA clinic in Alexandria who took excellent care of the patient and worked together with the nurses to get the leg to heal. It did not heal. In fact, it continued to deteriorate. The odor of rotting flesh was so bad that the nurses had to ensure that the windows were opened for their visits. The doctor referred him to the VA hospital in Texas for an amputation. After less than 24 hours, the patient was discharged because he had less than an ‘honorable discharge’.

The daughter explained that she finally found out that when father returned home from Viet Nam, he did not return a rental car in Washington DC. He left it at the airport but forgot to turn in the keys. Pardon me for being overly cynical, but I figured there was more to the story. The case manager placed a call to the VA’s office in Alexandria and confirmed the story. It didn’t seem to matter that he had been receiving VA benefits for years and did not apply for Medicaid when he was eligible because he was a vet and he trusted the VA system. It did not matter that he had been disabled for years but he would not be eligible for Medicare until he had been on Medicaid for two years.

He was just a vet – a sick and damaged individual no longer of use to the country he served.

The hospital wheeled him out to the sidewalk and luckily he had a niece in Texas who came and picked him up and took him to her house until his daughter could make the six hour ride to Houston in a truck that did not start very often.

We called The Department of Health in TX and left a message. The immediately returned my call but explained that they did not have the authority to survey VA hospitals. She gave me a number to call and I called it numerous times for about a week. I left messages. The agency did the same thing. Nobody was interested in the vet with the necrotic leg.

Now they have a secret waiting list that shows that veterans are waiting months for appointments but they altered their data to show that patients are being seen within the guidelines. The wait time is horrible in itself. The complicated steps to hide the list and create the appearance of compliance with the VA rules is nothing short of immoral. My clients would be accused of fraud if they altered any records and I would be in the courtroom testifying against them if they allowed people to die and hid the evidence.

This type of disrespect for our veterans of war could only be the result of a culture that fires anyone who presents a problem. Only in a system where individuals know that nothing they can do will ever make a change would this sort of thing happen.

Secretary Eric Shinseki has failed as a leader. He has created a culture where it somehow makes sense to lie, cover up and let people die rather than report the truth about how our veterans are treated. If this were one hospital or a dozen patients, I could believe it was hidden to him. He had a responsibility to know about 40 deaths on his watch. If he didn’t, it was because he chose not to know.

In spite of that, I do not want Secretary Eric Shinseki to resign. I want to see him fired. He does not deserve the dignity of being allowed to resign. If the President wants to show any conviction regarding the state of our VA hospitals, he needs to step up to the plate and get rid of Shinseki loudly and publicly.

It isn’t enough for Eric Shinseki that we send these young men and women to battle fields to risk their lives for our freedom. It doesn’t matter to Eric Shinseki that a good many of these same men and women who make it back home are permanently scarred or broken because of the battles they fought for him. The only thing that matters to Eric Shinseki is that he doesn’t look bad in the press. He fires a couple of people and assumes the situation will go away because that is how narcissists handle problems. They blame everyone else and sever ties with those that do not reinforce their inflated self image. I would have had so much more respect for the man if he was as horrified as I was about the delays and set about working towards a solution instead of defending his image. He should have stuck with making bad decisions about army fashion.

The toll-free number for the Veterans’ Benefits Office is 1-800-827-1000.

You can also go here to contact your elected officials and most government agencies. I am running very short on time this week but I will take the time to email everyone I can about this. I hope you do, too, because the who have been tasked with taking care of our veterans are an embarrassment to the United States.

Your comments are most welcome. Please feel free to include a link to this post in your correspondence if you agree with it. If you know anything that I don’t know, please share.

Sorry dear, you failed this time. Eric Shinseki did not create this culture. This culture has been here since very long before the current administration. Don’t let anyone fool you about it. Everyone always like’s to blame the current guy, no matter who or what, for creating a mess. You can’t do that this time. You can fault him for not fixing it. I’ll give you that one.

I recognize that it didn’t happen overnight and I remember the scandal in 2007. You are right about that.

You are also correct in that everyone likes to blame the current guy regardless of who created a mess. Heads have already rolled. BUT, as you stated, I can fault him for not fixing it OR not knowing about it. When a mess of this magnitude exists, you can spend literally decades trying to find out who is to blame. But also, a mess like this cannot exist unless there is a culture where people are less afraid of someone dying than identifying a problem and trying to find a solution.

You and I both know that we can teach compliance until the cows come home but if the senior level of management doesn’t buy into compliance, it is worthless. That is my point. Shenseki has been in place for 5 years. He had a responsibility to know about and do something about it. There have been numerous people fired at multiple hospitals. The story we are given is that Shenseki didn’t know about and then he found out about it, fired some people and now wants to investigate. Seems to me the sequence is out of order.

Trust me, I know it happens in Non-VA hospitals, too. Non-VA hospitals, as you stated have to answer to the state and survey results are public.

What would have impressed me was if Shenseki went to the hospitals in question, put together a credible team of investigators and found out exactly what was going on before he started firing people. Because if the scale of this problem is even half as large as it seems, then either everyone needs to be fired OR change needs to be the focus.

Tomorrow should be interesting when he testifies before congress. I would like to point out that nothing gets fixed while he’s on the hill explaining himself.

Oh yes, the VA. I have had some of their patients in the past. The waiting, the lack of communication. It has been a problem for as long as I can remember. And yet, the patients that I have seen always got what they needed whether it was an approved treatment or not. They did not have to prove they were worthy, or jump through insurance hoops, or pay huge co-pays and out-of-pocket costs. They got what the doctor ordered for them, it was never denied.

I think you have to weigh the good and the bad. It seems like a bare-bones system, yet when you consider that these patients I have seen were veterans, not active-duty, they were blessed to have anything at all. What hospital system would continue to cover you when you are no longer employed there?

This is an example of what things might be like if we truly had socialized medicine. There is risk in anything, and there are always cost vs. benefits. I think it is a system of last resort, but it is a perk of serving. While it does not meet the standards of our proud QI-oriented competitive hospitals of today, it serves a different role, so maybe it shouldn’t be seen in quite the same light?

I am not trying to excuse what they did, but if my husband, a veteran, ever comes to dire circumstances where he needs a provider of last resort, I am glad to know the VA is there for him.

Oh yes, the VA. I have had some of their patients in the past. The waiting, the lack of communication. It has been a problem for as long as I can remember. And yet, the patients that I have seen always got what they needed whether it was an approved treatment or not. They did not have to prove they were worthy, or jump through insurance hoops, or pay huge co-pays and out-of-pocket costs. They got what the doctor ordered for them, it was never denied.

I think you have to weigh the good and the bad. It seems like a bare-bones system, yet when you consider that these patients I have seen were veterans, not active-duty, they were blessed to have anything at all. What hospital system would continue to cover you when you are no longer employed there?

This is an example of what things might be like if we truly had socialized medicine. There is risk in anything, and there are always cost vs. benefits. I think it is a system of last resort, but it is a perk of serving, and while it does not meet the standards of our proud QI-oriented competitive hospitals of today, it serves a different role, so maybe it shouldn’t be seen in the same light?

I am not trying to excuse what they did. But if my husband, a veteran, should ever come into dire circumstances and need a provider of last resort, I am glad to know that the VA is there for him.

You make some excellent points. I hope I was clear that the VA doc in our experience worried very hard together with my client to save the gentleman’s leg. He was good. Nobody joins the army for the money. The ongoing benefits such as education and healthcare are part of their compensation.

I think where the situation turns wrong is the cover-up. Nobody fixes things they don’t know are broken.

Have you ever really screwed up? I mean like giving aaa handful of psych meds to the wrong patient? I have. Did you pretend it never happened? I bet not. Would your colleagues participate in your cover-up? I hope not.

Let this be a warning to you on what a single payer system can look like. When the regulations become too onerous, they are bypassed. Healthcare, as we know it will not survive in a single payer system.
I experienced military medicine 30 years ago, as a new army wife when the soonest appointment I could get for a little “honeymoon cystitis” was 6 weeks out. Can you imagine what my kidneys would have looked like by then? Thank God I worked in a private hospital and hit up one of the physicians for a script for Bactrim.

You make a valid point. I didn’t want to go there but was hoping someone would. Yes. Make no mistake. The best insurance we have right now is to eat right exercise and do all we can to make healthcare a place where we work instead of a system we depend on for our Welfare.

Julianne, you are absolutely spot on with this one. Shenseki has been there 5 years and if he was a leader, he would have already known these problems existed and had an action plan in place to correct. Instead he is having to be reactive and appear before Congress to explain himself. It’s time for radical change in the VA healthcare system.

I’ve tried contacting the local clinic here several times only to be routed to the Chicago office who knows nothing about what I am talking about only to be shuffled back to the local office where it would ring endlessly only to have someone finally pick up the phone and tell me the doc I need to speak with is not there and no one else is available to answer my question but if I leave a message they can call back….only to never have the call returned and have to go through the process all over again! IT’S A MESS!!!

When it is impossible to get in touch with a human being who will actually listen to you and do their best to work towards a solution or at the very least, apologize, the message sent is that you are not important enough to warrant their time. This is the problem with many bureaucracies and large entities. The very best we can do is learn from it and never make a patient or family member or employee feel small and insignificant.

here was an interesting comment made by the public affairs offers of IAVA – reminded me of Dear Abbey and divorce – he said in more polite words – are we better off with him or without him? He didn’t know the answer. But when you look at how hard it is to get an appointment confirmed in the senate, you decide if 3 months without a person at the top is better than what we have.

I’ll tell you though, why the VA has the backlog from you know where. In private practice, to make budget, a PCP sees between 8-12 patients an hour. Much less and his practice looses money. He generally sees each patient less than 5 minutes.

At the VA each patient gets about 15-30 minutes of MD time. The VA is horribly short of MDs to see the number of patients that get added to their census regularly – and many VA hospitals use few NPs, and only occasional PAs. That’s why vets who get in feel they get good care.

Now do they? From a nurse’s standpoint, their P&P are back in the dark ages, but what most patients feel is good care is time and listening to their needs. They get that.

I hope I brought that out in my original post. The Vidalia patient did get excellent care from his VA doc in Alexandria. I also think the wait list is understandable. Hiding it, wide spread cover ups, etc. is what offends me to the core. Nobody has a vested interest in fixing problems that are not brought out into the light.

You mentioned nurse practitioners and PA’s being very short. I agree that most physicians do not take enough time with docs in the private sector and I do not think the VA docs are taking too much time with patients. I think if the backlog had been known, lots of people could have worked at creative solutions. Much of the work done by the physicians could be done by nurses. A wound care nurse is better than most physicians at wound care. Psychiatric patients – especially the veterans need someone to listen to them. Does it need to be a physician?

During the senate hearings, the point was made that the 40 deaths may not have been attributable to the wait list. That got under my skin. Forget about the deaths. What about patients who are waiting for an appointment because the voices in their heads are telling them to blow up something? What about the vet who is in pain because of an injury suffered during the time he or she served? These people will end up in hospitals if they are lucky. If they are not lucky, the will end up in jail or addicted to pain medications because no doc should approve physical therapy until a diagnosis is made.

I could go on forever about potential solutions and if I involved you and the rest of the readers of our little blog, we could have a plan written in a day. It might fail in some areas and so be it. We tried because we knew about the problem. Failure is just another opportunity to get it right. On the other hand if we failed and said we succeeded, we should be held accountable for every death, every hospitalization related to an exacerbation of a disease process and every minute of pain a vet suffered after the point that we lied.

Your point about money is well taken. If the VA hospitals had to make a profit, the wait list would drop overnight but so would the quality of care.

A lot of people have brought up prior investigations into the quality of care at the VA hospitals. I remember those reports and with God as my witness, I thought that most of the problems had been resolved. To hear that nothing has changed makes me worry about this problem. When the press finds another interesting story, do we forget about this and the VA goes on as usual?